Ralstonia pickettii bacteremia in hemodialysis patients: a report of two cases. / Bacteriemia por Ralstonia pickettii en pacientes en hemodiálisis: reporte de dos casos.

Ralstonia pickettii is a low-virulence gram-negative bacillus that may be associated with infections related to health care and may cause bacteremia. Ralstonia pickettii bacteremia is uncommon but is related to the contamination of medical products, mainly in immunodepressed patients. We present two cases of patients on chronic hemodialysis with Ralstonia pickettii bacteremia linked to contamination of the dialysis water. Similar cases have been published with links to intravenous fluid administration, medication ampules, and the use of extracorporeal oxygenation membranes, among other factors. The detection of Ralstonia pickettii bacteremia should provoke suspicion and a search for contaminated medical products, fluids, and/or medications.

Bacteriemia por Ralstonia pickettii en pacientes en hemodiálisis: reporte de dos casos / Ralstonia pickettii bacteremia in hemodialysis patients: a report of two cases

RESUMEN Ralstonia pickettii es un bacilo gram negativo de baja virulencia que puede asociarse a infecciones relacionadas a los cuidados de la salud y provocar bacteriemias. La bacteriemia por Ralstonia pickettii es poco frecuente pero se relaciona con la contaminación de productos de uso médico principalmente en pacientes inmunodeprimidos. Presentamos dos casos en pacientes en hemodiálisis crónica vinculados a contaminación del agua de diálisis. Se han publicado casos similares vinculados a la administración de fluídos intravenosos, ampollas de medicación, asociado a membranas de circulación extracorpórea, entre otros. La detección de una bacteriemia por Ralstonia pickettii, debe sospechar e iniciar la búsqueda de productos de uso médico contaminados, fluídos y/o medicación.

ABSTRACT Ralstonia pickettii is a low-virulence gram-negative bacillus that may be associated with infections related to health care and may cause bacteremia. Ralstonia pickettii bacteremia is uncommon but is related to the contamination of medical products, mainly in immunodepressed patients. We present two cases of patients on chronic hemodialysis with Ralstonia pickettii bacteremia linked to contamination of the dialysis water. Similar cases have been published with links to intravenous fluid administration, medication ampules, and the use of extracorporeal oxygenation membranes, among other factors. The detection of Ralstonia pickettii bacteremia should provoke suspicion and a search for contaminated medical products, fluids, and/or medications.

Ralstonia pickettii bloodstream infections at a Brazilian cancer institution.

We describe a series of Ralstonia pickettii bloodstream infections (BSI) that occurred in 19 oncohematologic patients admitted to a hospital for patients with cancer, in the city of Rio de Janeiro, from July 1999 to February 2006. Fifty-four R. pickettii isolates were recovered from blood and catheter-tip specimens (1-5 isolates per patient). Two patients eventually died of causes unrelated to R. pickettii BSI. Eight pulsed-field gel electrophoresis genotypes were resolved (A-H), with two detected in more than 1 patient: genotype B, in 2 patients (1.5%), and E, in 12 patients (63.2%). R. pickettii emerged as a new pathogen at our institution, causing at least one outbreak. Cross-transmission of the pathogen, infusion of a putative contaminated intravenous solution, and persistent colonization of medical devices were the likely sources of R. pickettii BSI.